**2. Etiology of anxiety disorders**

#### **2.1 Biological factors**

In twin studies conducted, it was concluded that genetics was a huge factor. Structural neuroimaging studies in patients with panic disorder indicate pathological involvement in the temporal lobes, especially in hippocampus [9].

Although many neurotransmitters are effective in the pathophysiology of anxiety disorders, disorders in serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) appear to be the most important. GABA has an important place among the causes of anxiety disorder. As the drugs used in the treatment of anxiety disorders increase GABA, it is thought that the insufficiency and imbalance in GABA are directly related to the anxiety experienced [3, 5]. Serotonin is another neurotransmitter linked to anxiety disorder. Deficiency or an imbalance of serotonin in the amygdala is observed in anxiety-related disorders. It is known that there is imbalance in the regions related to norepinephrine in anxiety disorders.

It has been revealed that the CRF (Corticotropin-Releasing Factor) system plays an important role among the biological causes of anxiety disorders [1].

#### **2.2 Brain areas affected in anxiety disorders**

The brain areas affected by anxiety disorders and the symptoms they cause are listed below:

• Amygdala: Fear, which is especially important in panic and phobic disorders.

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• Brain stem: respiratory movement, heartbeat

• Frontal cortex: Cognitive interpretations

• Thalamus: Integration of sensory impulses

• Hypothalamus: activation of the stress response

**Psychodynamic Theory:** According to the psychodynamic view, anxiety is a state of tension that emerges in the self as a result of threats originating from within and outside the individual. Starting from childhood, repressed emotions, desires, impulses, experiences occasionally disturb the individual's self in the following years. A conflict arises between the self (ego), lower self (id), and upper self (superego), which creates anxiety in the individual. Anxiety is a harbinger of danger to the self, and the self tries to reduce anxiety by using self-defense

Freud argued that the child experiences anxiety specific to each period during the development process. These are superego anxiety, castration anxiety, fear of losing love, separation anxiety, annihilation anxiety, and disintegration anxiety. **Behavioral Theory:** According to this theory, anxiety is an emotional experience developed based on the urge to escape from congenital pain or suffering. This theory suggests that if an individual experiences intense fears and stressful events in early periods of life, s/he is likely to experience high levels of anxiety in his/her later life. Fear responses acquired through conditioning, observation, and social learning cause "escape" and "avoidance" behaviors to be triggered, thereby reducing anxiety. The escape and avoidance behaviors are thus reinforced, and when any kind of anxiety is experienced, they come into play and the anxiety is prevented from fading. Thus, the continuity of anxiety is ensured

**Cognitive Theory:** In Beck's theory, how we interpret and perceive events deter-

mines our emotions; in other words, it is the meaning attributed to them rather than the events themselves that trigger our emotions. This interpretation depends on the characteristics of the environment in which the event occurs, the mood at the time of the event, and the past experiences of the individual. Individuals experience

In DSM 5, anxiety disorders are divided into eleven subgroups. These are:

anxiety due to their false reasoning and irrational beliefs [1, 3].

**4. Classification of anxiety disorders**

• Separation anxiety disorder,

• Selective mutism,

• Panic disorder,

• Locus coeruleus: Vigilance

• Basal ganglia: Tremors [10]

**3. Psychological theories**

mechanisms [11].

in this way [11].

• Hippocampus: Depends on memory which is related to fear responses.

*Anxiety Disorders DOI: http://dx.doi.org/10.5772/intechopen.93952*

• Locus coeruleus: Vigilance

*Anxiety Disorders - The New Achievements*

areas.

**1.3 Epidemiology**

**2. Etiology of anxiety disorders**

**2.1 Biological factors**

and intensification of anxiety symptoms may cause anxiety disorders. Anxiety can be evaluated as pathological when it begins to have an impact on social and occupa-

In short, anxiety can be deemed pathological if the following situations occur:

b.When anxiety inhibits social, occupational, and other important functional

Example: Ms. M., who was involved in a serious traffic accident a month ago, refuses to drive even to places in short distances. Her father has to take Ms. M. whenever she needs to go somewhere. Ms. M., who constantly refuses to drive, has

Anxiety disorders are the most common of all psychiatric illnesses and result in significant functional impairment and distress [5, 6]. Its prevalence per year is reported as 17.7%. This rate is 30.5% for women and 19.2% for men, and the frequency decreases with the increase in socioeconomic level [7]. In a study conducted by Özcan et al. (2006), anxiety disorder was found to be the most common diagnosis among 950 psychiatric patients, and it was mostly observed in women,

In twin studies conducted, it was concluded that genetics was a huge factor. Structural neuroimaging studies in patients with panic disorder indicate pathologi-

Although many neurotransmitters are effective in the pathophysiology of anxiety disorders, disorders in serotonin, norepinephrine, and gamma-aminobutyric acid (GABA) appear to be the most important. GABA has an important place among the causes of anxiety disorder. As the drugs used in the treatment of anxiety disorders increase GABA, it is thought that the insufficiency and imbalance in GABA are directly related to the anxiety experienced [3, 5]. Serotonin is another neurotransmitter linked to anxiety disorder. Deficiency or an imbalance of serotonin in the amygdala is observed in anxiety-related disorders. It is known that there is imbal-

It has been revealed that the CRF (Corticotropin-Releasing Factor) system plays

The brain areas affected by anxiety disorders and the symptoms they cause are

• Amygdala: Fear, which is especially important in panic and phobic disorders.

• Hippocampus: Depends on memory which is related to fear responses.

housewives, married people, and people with a low education level [8].

cal involvement in the temporal lobes, especially in hippocampus [9].

ance in the regions related to norepinephrine in anxiety disorders.

**2.2 Brain areas affected in anxiety disorders**

an important role among the biological causes of anxiety disorders [1].

a.When anxiety is not proportional to the situation that creates anxiety,

tional actions, achievement of desired goals, and emotional state [4].

even had to quit her job because of her anxiety about driving.

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listed below:


### **3. Psychological theories**

**Psychodynamic Theory:** According to the psychodynamic view, anxiety is a state of tension that emerges in the self as a result of threats originating from within and outside the individual. Starting from childhood, repressed emotions, desires, impulses, experiences occasionally disturb the individual's self in the following years. A conflict arises between the self (ego), lower self (id), and upper self (superego), which creates anxiety in the individual. Anxiety is a harbinger of danger to the self, and the self tries to reduce anxiety by using self-defense mechanisms [11].

Freud argued that the child experiences anxiety specific to each period during the development process. These are superego anxiety, castration anxiety, fear of losing love, separation anxiety, annihilation anxiety, and disintegration anxiety.

**Behavioral Theory:** According to this theory, anxiety is an emotional experience developed based on the urge to escape from congenital pain or suffering. This theory suggests that if an individual experiences intense fears and stressful events in early periods of life, s/he is likely to experience high levels of anxiety in his/her later life. Fear responses acquired through conditioning, observation, and social learning cause "escape" and "avoidance" behaviors to be triggered, thereby reducing anxiety. The escape and avoidance behaviors are thus reinforced, and when any kind of anxiety is experienced, they come into play and the anxiety is prevented from fading. Thus, the continuity of anxiety is ensured in this way [11].

**Cognitive Theory:** In Beck's theory, how we interpret and perceive events determines our emotions; in other words, it is the meaning attributed to them rather than the events themselves that trigger our emotions. This interpretation depends on the characteristics of the environment in which the event occurs, the mood at the time of the event, and the past experiences of the individual. Individuals experience anxiety due to their false reasoning and irrational beliefs [1, 3].

#### **4. Classification of anxiety disorders**

In DSM 5, anxiety disorders are divided into eleven subgroups. These are:


#### **4.1 Separation anxiety disorder**

Separation anxiety disorder can be defined as experiencing fear and anxiety that is more than expected and repetitive in terms of developmental level resulting from separation from home or someone the person is attached to for at least four weeks in children, and for at least six months or longer in adults. It is seen that individuals with separation anxiety disorder do not want to go to school or elsewhere because of the fear of separation. The main feature of separation anxiety disorder is excessive anxiety caused by leaving the mother, father, home or familiar environment. It is seen equally in boys and girls.

*Etiology:* According to the psychodynamic approach, children who are attached ambivalently are very busy with the care of their caregivers, which reduces their exploration behaviors of their environment and thus causes separation anxiety to develop. Stressful events such as parental divorce, illness, loss are important risk factors for separation anxiety disorder. In a study, it was found that the depressive, cyclothymic, irritable and anxious temperament scores of the mothers of children with separation anxiety disorder were higher than the control group [13].

Symptoms in separation anxiety disorder differ according to the developmental period. In children aged 5-8 years, the fear of a bad event and rejection of school, intense distress during separation at the age of 9-12, school refusal in adolescents aged 13-16, and physical complaints appear as symptoms.

*Comorbidity:* Frequently, depression, bipolar disorder, hyperactivity disorder, personality disorders and other anxiety disorders are seen together.

*Treatment:* In the treatment of separation anxiety disorder, the most important point is planning to include the family, school and child. Cognitive therapy is one of the effective methods. Antidepressants, selective serotonin reuptake inhibitors, are used in drug therapy. One study suggested that vilazodone can be used in the treatment of separation anxiety disorder [14].

#### **4.2 Selective Mutism**

The most important feature of this disorder is that although the individual can speak in other situations, s/he constantly does not speak in certain specific social situations (when s/he meets people s/he does not know, etc.) where s/he is expected to speak. The disorder must last at least one month and affect the person's education, work success, and social life. It usually occurs in the preschool period.

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**4.3 Panic disorder**

attack. These are:

• Sweating

• Shaking or trembling

• Choking sensation

• Chills or hot flushes

• Fear of dying [12]

detached from oneself)

• Fear of losing control and going crazy

• Chest pain or discomfort

• Nausea or abdominal distress

• Feeling short of breath or smothering

• Feeling dizzy, lightheaded, unsteady or faint

• Paresthesias (tingling and numbness sensations)

• Derealization (unreal feelings) or depersonalization (feelings of being

Panic disorder, which is a very old disease, is a syndrome characterized by sudden and extreme anxiety with unreasonable and unpredictable panic attacks. Its most important feature is that it is accompanied by intense physical discomfort. Panic attacks can occur only once, or frequently, on a weekly, monthly or even annual basis. Panic attack disorder is usually seen in the 20s. The panic attack is an unreasonable and severe state of anxiety. During panic attacks, symptoms such

*DOI: http://dx.doi.org/10.5772/intechopen.93952*

preferred in pharmacological treatment.

*Etiology:* In the etiology of the disorder, there are reasons such as delay in language development, communication defects, lack of communication, presence of

In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) [American Psychiatric Association (APA)] it is stated that at least four of the following symptoms must be present to determine the presence of a panic

• Palpitations, pounding heart or accelerated heart rate

*Comorbidity:* Social phobia, obsessive-compulsive disorder, speech and language

psychiatric disorders in the family, and overprotection of the family.

disorders are among the disorders accompanying selective speech disorders. *Treatment:* Behavioral treatments, pharmacological treatments, group and family therapies are effective in treatment. It has been stated that the cognitivebehavioral approach especially encourages verbal and non-verbal forms of communication. In family therapy, it is important to identify healthy and dysfunctional family relationships and to raise awareness of family members about unhealthy communication patterns and behaviors. Selective serotonin reuptake inhibitors are

#### *Anxiety Disorders DOI: http://dx.doi.org/10.5772/intechopen.93952*

*Etiology:* In the etiology of the disorder, there are reasons such as delay in language development, communication defects, lack of communication, presence of psychiatric disorders in the family, and overprotection of the family.

*Comorbidity:* Social phobia, obsessive-compulsive disorder, speech and language disorders are among the disorders accompanying selective speech disorders.

*Treatment:* Behavioral treatments, pharmacological treatments, group and family therapies are effective in treatment. It has been stated that the cognitivebehavioral approach especially encourages verbal and non-verbal forms of communication. In family therapy, it is important to identify healthy and dysfunctional family relationships and to raise awareness of family members about unhealthy communication patterns and behaviors. Selective serotonin reuptake inhibitors are preferred in pharmacological treatment.
